Thank you for your interest in the TRIO-Student Support Services program! Due to the nature of the TRIO-SSS program being funded through a grant from the United States Department of Education, we will need you to provide some personal and financial information to determine your eligibility.  All of the information you provide will be kept confidential and only be viewed by the TRIO-SSS Staff.

So that we may determine your eligibility and begin to provide you with services, please take a few minutes to complete the application in its entirety. Be sure to include all signature where required and all supporting documentations, as noted.

*Note: You cannot save and restart this application. Therefore, you may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (808) 844-2366 or email us at hontrio@hawaii.edu
General Information:
Last Name: *
First Name: *
Middle Name *
Date of Birth *
Honolulu CC School ID#
Marital Status (M: Married/S: Single)
Gender (F: Female/M: Male) *
Mailing Address *
Mailing Address 2
Mailing City *
Mailing Zip Code *
Phone Number (input cell# if no home number) *
Cell Phone Number *
HCC Email Address *
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Academic Information:
Semester and Year Entering/Entered HCC (i.e. Spring 2022) *
I am Entering/Entered HCC as a: *
Is Honolulu Community College Your Home Campus? *
Do Your Have a 2-Year College Degree? *
Do You Have a 4-Year College Degree? *
I Have Earned the Following College Credits *
What Is Your Academic Standing? *
I Earned a: *
How Many Classes Are You Enrolled/Or Planning to Enroll In? *
Is English Your First Language?
My Program of Study (Major) is: *
I Plan to Earn a: *
Do You Plan to Transfer to Another College? *
I Have Taken or Plan to Take: (Select One) *
Eligibility Information:
Citizenship:
Are you a Citizen, National, or Permanent Resident of the United States?
First-Generation College Student:
Mother's Educational Level: *
Father's Educational Level *
Have you ever been in foster care or in a court appointed guardianship? *
Documented Disability:
Do You Have a Documented Disability? *
Are you receiving academic accommodations through Student ACCESS (HCC's Disability Services Office)? *
If Applicable: Upload Disability Documentation
Race/Ethnicity (answer all & select all that apply):
Race, American Indian or Alaskan Native *
Race, Asian *
Race, Black or African American *
Race, Hawaiian or other Native to Pacific Island *
Race, Hispanic
Race, White *
Veteran Status:
Are you a Veteran of the Unites States? *
Low-Income Verification:

TRIO-SSS is a program federally funded through the United States Department of Education, and for grant compliance, we require supporting documents to verify program eligibility. Information for this section will be strictly in determining your eligibility.  Please take a moment to read through and complete this section.  We assure you that we will keep this and all information confidential.

An Independent Student is one of the following: at least 24 years old, married, a graduate or professional student, a veteran, a member of the armed forces, an orphan, a ward of the court, or someone with legal dependents other than a spouse, an emancipated minor or someone who is homeless or at risk of becoming homeless.

If you do not meet any of the criteria for being an Independent Student, you are considered Dependent Student (parents claim you on their federal taxes)
I am submitting the following tax forms as a: *
Upload Most Recent IRS 1040
Taxable Income (line 15 on from 1040)
Federal Taxes (form 1040) Filed in the State of:
Number of Dependents Claimed on form 1040
Financial Aid Information
Did you Apply for FAFSA (Financial Aid) *
Are you receiving Federal Pell Grant? *
Academic Need:
Academic Need (select at least one) *
Which TRIO services are you interested in? (check all that apply)
Student Success Class (IS103)
Academic/Career/Personal/Transfer/Financial Advising
FAFSA Assistance & Information/Financial Literacy
Tutoring & Coaching
Computer Use/Printing
Life/Study Skills Assistance
Borrow Resources (textbooks, voice recorder, calculator, etc..)
Cultural/Educational/Service Learning Events
Early Registration
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Resource Loan Out Policy/Contract:

The TRIO-SSS program provides a resource "loan out" service for all eligible participants.  Eligible participants requesting to borrow any resources for use outside of the TRIO-SSS program will need to abide by the following rules:

1. You must be an accepted participant in the TRIO-SSS program based on the guidelines set by the Department of Education.

2. You (the borrower) must be at least 18 years of age. If you are under the age of 18, you will need a parent or guardian to sign this form (below), acknowledging the rule and responsibilities for the borrower. 

3. You (the borrower) will be allowed to borrow:

  • Video camera & digital camera for a period of no more than 48 hours. When borrowed on a Friday or a holiday, it will be due the following school day by 11:00am. The due date and time will be indicated on the loan out slip provided to your by a TRIO-SS staff at the time of loan out.
  • Books, digital voice recorder, calculator, and other resources for a period no more than one week. When borrowed on a Friday or a holiday, it will be due the following school day by 11:00am. The due date and time will be indicated on the loan out slip provided to your by a TRIO-SS staff at the time of loan out.

4. Should you fail to return the borrowed item(s) on time, you (the borrower) will be subject to the overdue policy.  If you the borrow fail to return the borrowed items with 48 hours of the due date, the TRIO-SSS program has the right to proceed with institutional polices and procedures and place a hold & charge your student account for the replacement cost of the items(s). 

5. If you (the borrower) wish to extend your check out items for additional time, you are required to return the borrowed item(s) first, and then place your name at the bottom of the sign out list for the next available day.  Resources are loaned out on a first come, first served basis. There will be no exceptions. 

6. When returning the borrow item(s), you (the borrower) are required to bring it back yourself. If another person other than the borrower returns the borrowed item(s), you will lose loan out privilege's for the remainder of the semester. 

7. You (the borrower) will be responsible for the proper care of the borrowed item(s). Should any borrowed item(s) be lost, stolen, damaged, altered or destroyed in any manner (physical or systematic), you (and/or the signed parent/guardian) will be liable for the total repair of replacement cost of the lost, stolen, damaged, altered or destroyed item(s). 

8.  You (the borrower) promise to utilize: The borrowed items(s) with care in an ethical manner for academic purposed only and will not utilize the item(s) for an inappropriate illegal activities. 

9.  Upon returning: All borrowed item(s) must be returned in the presence of a TRIO-SSS Staff member so that the status of the borrowed item(s) may be checked thoroughly.

10. All borrowed resources are inspected prior to items being released.

I have read and understood the conditions listed above in borrowing TRIO-SSS resources.  By signing this policy contract, I agree to comply with the rules stated above with the understanding that, I will be held liable for the total cost to repair or replace the resource(s). Furthermore, I understand that future borrowing privilege's at the TRIO-SSS program can be revoked and or I may be subject to their disciplinary actions deemed to be appropriate by the TRIO-SSS program and/or HCC. 
Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Photo Release:
I give Honolulu Community College, TRIO-SSS program the absolute right and permission to use my photograph in its promotional materials and publicity efforts. I understand that the photographs may be used in a publications, print, direct-email/mail pieces, electronic media, (i.e. video, internet, social media platforms), or other forms of promotion. I release HCC, TRIO-SSS program the photographer their, offices, employees, agents and designees from liability for any violations of any personal or proprietary right I make have in connection with such use. 
Authorize Photo Release *
Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Authorization & Verification 

1. I understand that the TRIO-SSS program is funded through a federal grant from the U.S. Department of Education and required to verify my eligibility utilizing the information included in this application & supporting documents.

2. I hereby authorize Honolulu Community College TRIO-SSS staff to obtain academic, financial, and other information pertinent to my participation in the TRIO-Student Support Services program.

3. I understand that my application and its contents will be kept in a file at the TRIO-SSS program office and will be kept confidential in compliance with the Family Educational Rights and Privacy Act (FERPA).

4. I understand that the TRIO-SSS program is not responsible for any grades I receive. The program is only responsible for the clarification of the subject matter and for suggestions on how to improve my chances for success.

5. I understand that completion of this form does NOT guarantee acceptance into the TRIO-SSS program.

6. I understand that I should maintain an open mind and positive attitude toward students, peer tutors/coaches, and other TRIO-SSS staff members.

7. I will be a responsible student and adhere to Honolulu Community College/Institutional Student Conduct Code.

8.  I will respect the rights of others, including belongings, personal space, the right to personal opinion, and privacy.

9. I will refrain from inappropriate behaviors, profanity, outbursts, or any other threatening behaviors toward myself or others.

10. I understand that once I am accepted into the TRIO-SSS program, I have a participant obligation to update my files as requested by the program and remain in active status.

11. I understand that if, for any reason, the Project Director feels that your participation is detrimental to the program or other students, you will be dismissed/removed.

12. I certify that the information contained herein is true and complete to the best of my knowledge.
Sign and Submit:
Terms of Submission: By submitting this application, I acknowledge that all of the above information inputted in this application is correct and accurate to the best of my understanding.
Applicant Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature (if applicant under age 18)
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.